Factors influencing delay to diagnosis and treatment among pediatric oncology patients at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: a cross-sectional survey

BACKGROUND: Childhood cancer represents a significant cause of morbidity and mortality among children under 15 years of age and is a growing public health concern, particularly in low- and middle-income countries, including Ethiopia. OBJECTIVE: The purpose of this study was to assess factors Influencing delay to diagnosis and treatment initiation among pediatric cancer patients attending at Tikur Anbessa Specialized Hospital oncology unit in Addis Abeba, Ethiopia, in 2019. METHODS: An institutional-based cross-sectional study involving 244 pediatric cancer patients was conducted between February and April of 2019. Data were collected from parents/caregivers using a structured questionnaire through face-to-face interviews and supported by review of medical records. Bivariate and multivariate analyses with adjusted odds ratios were employed to evaluate the association between dependent and independent factors. Statistical analysis was performed using STATA (Version 14) with a significance level of P < 0.05. RESULT: A total of 244 children participated, with an average age of 6.4 (± SD 3.2 years). One hundred twenty-seven (52.0%) were reported as patient delays (> 30 days), while 179 (73%) were reported as health system delays. Children aged 5-9 years AOR:2.98; 95% CI,1.35, 6.57; three times delayed than children 0-4 years; where as children from rural areas AOR:2.28; 95% CI, 1.07, 4.88; were about 2.28 delayed as compared to children who come from urban. Furthermore, parents of children who visited traditional healers AOR: 7.85, 95% CI; 3.88,15.89 were more likely to be delayed as compared to their counter's parts. Health system-related factors, such as lack of medical insurance AOR: 5.52, 95%CI: 2.61, 11.69 and first visit to a health institution AOR: 16.13, 95%CI: 4.00, 65.03, were identified as the cause of delay. CONCLUSION AND RECOMMENDATIONS: In conclusion, prolonged patient and health system delays were significantly associated with age AOR: 2.98; 95% CI: 1.35-6.57), rural residence AOR: 2.28; 95% CI: 1.07-4.88, use of traditional healers AOR: 7.85; 95% CI: 3.88-15.89), low disease awareness, and lack of health insurance at diagnosis (AOR = 5.52; 95% CI: 2.61-11.69). To reduce delays, targeted health education for parents and healthcare providers, improved early detection and referral systems, strengthened multisectoral collaboration, expansion and decentralization of pediatrics oncology care facilities and further qualitative research to explore underlying causes of delay are recommended.